Affordable Care Act is dodging a public execution, but the health law could die anyway: Our view

The Trump administration does not seem to care that the Affordable Care Act, aka Obamacare, has allowed tens of millions of Americans to purchase health coverage, or that its insurance markets have proved remarkably resilient, or that its popularity has soared since its namesake left office.

Nor is it much impressed by the fact that the basic architecture of the ACA was originally a Republican idea, offered as an alternative to the unworkable plan spearheaded by former President Bill Clinton.

No, the Trump administration is determined to kill the program. Having failed to persuade Congress to do the deed, the White House is doing everything in its power to sabotage the law through administrative actions:

►Just this month, it announced 90 percent cuts in advertising to encourage participation and 40 percent cuts for "navigator" programs that help consumers sign up, and it stopped $10 billion in "risk adjustment" payments to insurers who accepted the sickest customers.

►And in April, it changed rules to allow states to cut back on coverage to those with costly pre-existing conditions.

These regulatory approaches come on top of the administration’s decision not to defend the ACA in a lawsuit brought by 20 conservative state attorneys general, and the Republican tax law’s repeal of the individual mandate.

The common agenda behind each of these actions is to destabilize the insurance markets that the ACA created. The slimmed down coverage, for instance, is likely to attract young and healthy patients who assume they will never need expensive care. These plans would not only leave them in a lurch should they get sick or have an accident, the policies would also mean lower insurance revenue to cover older and more expensive patients. Fewer sign-ups would also lower insurance revenue and spread risk among a smaller pool of the insured.

The result will be a death spiral of increasingly large premium increases, draconian copays and less and less competition to serve customers.

While not without its flaws, until now the ACA has been a success. It reduced the number of uninsured by 20 million people from enactment to 2016, a time when the overall population grew by 14 million. Obamacare has also played a role in slowing premium increases for employer-sponsored coverage — by cutting the number of uninsured patients who are effectively subsidized by these plans.

So why is the Trump administration stealthily trying to kill Obamacare? Trump and congressional Republicans campaigned on doing just that but were unable to do it directly through legislation. Each time they tried, a handful of Republicans balked at killing the program because they had no realistic replacement and did not want to be blamed when millions lost their coverage.

Instead, the Trump administration's regulatory sabotage approach minimizes the public notice and accountability that would come from showy House and Senate votes followed by an Oval Office signing ceremony.

In the end, the result will be the same. President Barack Obama's signature domestic achievement will have dodged a public execution, but it might die anyway. Republicans should be held accountable for their handiwork — even if they do it in a bureaucratic dark alley instead of openly in the halls of Congress.

USA TODAY's editorial opinions are decided by its Editorial Board, separate from the news staff. Most editorials are coupled with an opposing view — a unique USA TODAY feature.